Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil.
Otol Neurotol. 2012 Dec;33(9):1516-24. doi: 10.1097/MAO.0b013e31827137d2.
To report the results of cochlear implantation via the middle fossa approach in 4 patients, discuss the complications, and present a detailed description of the programming specifications in these cases.
Retrospective case review.
Tertiary-care referral center with a well-established cochlear implant program.
Four patients with bilateral canal wall down mastoid cavities who underwent the middle fossa approach for cochlear implantation.
Cochlear implantation and subsequent rehabilitation. A middle fossa approach with cochleostomy was successfully performed on the most superficial part of the apical turn in 4 patients. A Nucleus 24 cochlear implant system was used in 3 patients and a MED-EL Sonata Medium device in 1 patient. The single electrode array was inserted through a cochleostomy from the cochlear apex and occupied the apical, middle, and basal turns. Telemetry and intraoperative impedance recordings were performed at the end of surgery. A CT scan of the temporal bones was performed to document electrode insertion for all of the patients.
Complications, hearing thresholds, and speech perception outcomes were evaluated.
Neural response telemetry showed present responses in all but 1 patient, who demonstrated facial nerve stimulation during the test. Open-set speech perception varied from 30% to 100%, despite the frequency allocation order of the MAP.
Cochlear implantation via the middle cranial fossa is a safe approach, although it is a challenging procedure, even for experienced surgeons.
报告 4 例经中颅窝入路进行人工耳蜗植入的结果，讨论并发症，并详细描述这些病例的编程参数。
回顾性病例研究。
具有成熟人工耳蜗植入项目的三级转诊中心。
4 例双侧经迷路乙状窦后乳突腔患者，行中颅窝入路人工耳蜗植入术。
人工耳蜗植入及随后的康复。4 例患者均在耳蜗顶圈最浅表处成功施行中颅窝入路和耳蜗造口术。3 例患者使用 Nucleus 24 人工耳蜗系统，1 例患者使用 MED-EL Sonata Medium 设备。单个电极阵列通过耳蜗造口从耳蜗顶圈插入，占据顶圈、中圈和底圈。手术结束时进行遥测和术中阻抗记录。对所有患者进行颞骨 CT 扫描以记录电极插入情况。
评估并发症、听力阈值和言语感知结果。
除 1 例患者在测试过程中面神经受到刺激外，神经反应遥测显示所有患者均有反应。尽管 MAP 的频率分配顺序不同，但开放式言语感知率从 30%到 100%不等。
尽管对于经验丰富的外科医生来说，中颅窝入路进行人工耳蜗植入是一种具有挑战性的手术，但它是一种安全的方法。
